When Can You Work Out After Botox?

Botox treatments and exercise can be a bad mix. Find out how long (and why) you should wait before resuming your workout routine.

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Botox may have a reputation as an easy "lunchtime" treatment but it still comes with certain precautions. Of note, providers typically advise refraining from physical activity after your appointment.

While some people have zero hesitation when directed to skip a workout (🙋🏻‍♀️), maybe you have a strict training schedule and are wondering if abstaining from workouts is necessary or suggested in an abundance of caution. To put it bluntly, this is one rule you want to abide by since working out too soon after a Botox treatment could mess with your results.

Before digging into the 'why,' it could be helpful to brush up on what Botox even is.

What Is Botox?

Botox is an injectable treatment that contains botulinum toxin. Along with Dysport, Xeomin, Jeuveau, and the new FDA-approved Daxxify, Botox falls under a category of medication referred to as neuromodulators, meaning that it affects nerve signals. More specifically, when injected into a muscle, the botulinum toxin prevents a nerve signal that causes muscles to contract, creating a temporary paralysis of the muscle. Many people turn to Botox for cosmetic reasons, since the muscle relaxation effects can minimize the appearance of wrinkles and prevent new ones from forming, but providers also use Botox to treat conditions such as migraines or temporomandibular joint (TMJ).

Working Out After Botox: What You Need to Know

As for why working out right after Botox can be problematic, that boils down to a bit of science involving preservative proteins (also referred to as hemagglutinin proteins) that make up part of the Botox molecule. "After injection, it takes a few days for that preservative protein to disassociate from the active botulinum toxin molecule," and for the toxin to bind to the muscle, says Alan Durkin, M.D., founder of Ocean Drive Plastic Surgery. The preservative protein must first separate from the core molecule in order for Botox to do its job, he explains. Once separate, the core molecule is able to prevent nerves from releasing a chemical called acetylcholine, which normally triggers muscle contraction when your brain directs a muscle to move.

"However, during the timeframe between injection and Botox binding [to the muscle], there is an opportunity for the Botox to 'migrate' as it has not bound to the muscle," he says. (I.e., it can move away from where it was injected and affect a different muscle.) Workouts, and especially explosive exercises, can "accentuate and increase" the migration, says Dr. Durkin. The injection area that carries the biggest chance of migration is the "11 lines" between your eyebrows, and it can lead to eyelid ptosis (drooping), he notes. While rare, it's not something you want to press your luck with since the complication can last for months without any available recourse but time.

Exactly how long you should wait to work out post-Botox will depend on your existing fitness level and the intensity of your training. That's because your metabolic rate will influence how your body metabolizes Botox, says Dr. Durkin. (FYI, increasing your strength training and cardio can both contribute to raising your metabolic rate.) "Your metabolic rate will influence your Botox metabolism, as well as the metabolism of all neuromodulators," he says. "All [neuromodulators] are influenced by activity." Sedentary people typically notice an additional month of results compared to highly-active individuals, he adds.

How Long You Should Wait to Work Out After Botox

With that in mind, for athletes, Dr. Durkin suggests avoiding all exercise for 24 hours and waiting three additional days before returning to any rigorous workouts. Those three days can consist of light cardio that doesn't involve any bouncing or quick flexion and extension (bending and straightening) at the waist. This is because, again, quick, ballistic movements such as plyometrics or exercises that produce power and velocity, can cause the injected material to move around.

If you have a more modest fitness level, he suggests a slightly different timeline. You can return to light cardio after 24 hours and more intense exercise after 48 hours. In addition, he advises avoiding any advanced yoga or stretching for 48 hours, regardless of your fitness level. Holding various facial positions throughout yoga and stretching (think: hanging your head upside down during downward-facing dog, for example) can also cause the Botox to migrate, he explains.

Try Botox Alternatives

Note that opting for a different botulinum toxin injection can shave time off of your waiting period. "One option for getting someone back to exercise quickly is to use Xeomin, which is a preservative-free neuromodulator that binds almost immediately," says Dr. Durkin. "For these patients, all exercise regardless of intensity can be undertaken, including yoga, in 48 hours." Chalk it up to the aforementioned preservative proteins in Botox, which are absent in Xeomin due to a more extensive purification process. "Xeomin is literally the exact same molecule as Botox in terms of how it works, but there are no preservatives," says Dr. Durkin. "It is simply a purer form of Botox. Xeomin binds almost immediately to muscle, so its chances for migration are less in patients who like to move and exercise, i.e. athletes."

Another pro of Xeomin is that people who develop a high "tolerance" to Botox (i.e. start needing higher doses with the same effects) may not meet the same fate with Xeomin, says Dr. Durkin. That's thanks to a particular hemagglutinin protein (remember those?) that's found in Botox but absent in Xeomin. "Hemagglutinin-33 has been shown to cause an immunogenic response, meaning that hemagglutinin-33 may be responsible for the tolerance to Botox," says Dr. Durkin. In other words, it's less likely that your body will develop antibodies against Xeomin. Both options last anywhere from three to four months.

Whichever route you take, it'll be in your best interest to scale back on your workouts for a few days. Consider it an opportunity to protect your investment while reaping the benefits of regular rest days.

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